Prescription Drug Information

Most of the changes in drug coverage happen at the beginning of each year (January 1). However, during the year, the plan might
make many kinds of changes to the Drug List. For example, the plan might:

Add or remove drugs from the Drug List.

Move a drug to a higher or lower cost-sharing tier.

Add or remove a restriction on coverage for a drug.

Replace a brand name drug with a generic drug.

No changes at this time.

Changes to our Formulary (both additions and deletions) are also listed on this website in the following document.

Ultimate Health Plans is an HMO plan with a Medicare contract. Enrollment in Ultimate Health Plans depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Medicare beneficiaries may also enroll in Ultimate Health Plans through the CMS Medicare Online Enrollment Center located at www.medicare.gov. Ultimate Health Plans does not collect any member information through this website.